Background To assess the current landscape of the heart failure (HF) epidemic and provide targets for future health policy interventions in Medicare, a contemporary appraisal of its epidemiology across inpatient and outpatient care settings is needed.

Methods and Results In a national 5% sample of Medicare beneficiaries from 2002 to 2013, we identified a cohort of 2 331 939 unique fee-for-service Medicare beneficiaries ≥65-years-old followed for all inpatient and outpatient encounters over a 10-year period (2004–2013). Preexisting HF was defined by any HF encounter during the first year, and incident HF with either 1 inpatient or 2 outpatient HF encounters. Mean age of the cohort was 72 years; 57% were women, and 86% and 8% were white and black, respectively. Within this cohort, 518 223 patients had preexisting HF, and 349 826 had a new diagnosis of HF during the study period. During 2004 to 2013, the rates of incident HF declined 32%, from 38.7 per 1000 (2004) to 26.2 per 1000 beneficiaries (2013). In contrast, prevalent (preexisting + incident) HF increased during our study period from 162 per 1000 (2004) to 172 per 1000 beneficiaries (2013) (P_trend <0.001 for both). Finally, the overall 1-year mortality among patients with incident HF is high (24.7%) with a 0.4% absolute decline annually during the study period, with a more pronounced decrease among those diagnosed in an inpatient versus outpatient setting (P_interaction <0.001)

Conclusions In recent years, there have been substantial changes in the epidemiology of HF in Medicare beneficiaries, with a decline in incident HF and a decrease in 1-year HF mortality, whereas the overall burden of HF continues to increase.

背景技术为了评估心力衰竭（HF）流行病的当前状况并为医疗保险中的未来卫生政策干预措施提供目标，需要对住院和门诊护理环境中其流行病学进行当代评估。

方法与结果在2002年至2013年全国5％的Medicare受益人样本中，我们确定了年龄在65岁以上的2 331 939名独特的有偿服务性Medicare受益人，其后10年内所有住院和门诊病例都遵循该队列（ 2004–2013）。在第一年中，任何一次心力衰竭的发作都定义了已有的心力衰竭，而住院或两次门诊心衰的突发性心力衰竭也是如此。该队列的平均年龄为72岁；女性占57％，白人和黑人分别占86％和8％。在此队列中，在研究期间有518223名患者已存在心力衰竭，而349826位患者有新的心力衰竭诊断。在2004年至2013年期间，HF的发病率下降了32％，从每千名受益人的38.7（2004年）下降到每千名受益人的26.2（2013年）。相比之下，两者的P_趋势<0.001）。最后，在研究期间，发生心力衰竭的患者的总体1年死亡率很高（24.7％），在此期间每年绝对下降0.4％，在住院患者与门诊患者中诊断出的死亡率下降更为显着（P_相互作用<0.001 ）

结论近年来，医疗保险受益人的心力衰竭流行病学发生了重大变化，心力衰竭的发病率下降，一年期心衰死亡率降低，而心衰的总负担仍在增加。